­There's so much to think about when you're expecting a baby, from decorating the nursery to picking out names. Amidst all of the excitement, there are many important choices to make. Be a stay-at-home parent, or secure child care and return to work after the baby is born? Cloth or disposable diapers? Breast-feed or bottle-feed? Save the baby's cord ­blood, or not? That last question might be unfamiliar to you if you haven't been privy to any baby discussions lately, but it's a decision that today's parents must make.

Cord blood is essentially the blood from the umbilical cord of a newborn baby, although in actuality it should be called placental blood, as most of the blood is in the placenta. This blood amounts to as much as 180 milliliters, or 6 ounces, on average.

Since the early 1990s, there's been a movement to save, or "bank," this blood for potential future use. Cord blood is a source of a specific type of hematopoietic (blood forming) stem cell and can potentially cure a host of diseases and other conditions. Cord-blood-derived embryoniclike (CBE) stem cells are similar to embryonic stem cells, but with the plus of using something that was going to be thrown away anyway.

Does that mean that CBE stem cells are less controversial than embryonic stem cells? You'd think so, but that's not the case. Let's start with looking at how cord blood is collected and stored, as the latter is one of the sources of controversy.

Umbilical Cord Blood Collection and Storage

The actual process of collecting cord blood takes just a few minutes, but parents must decide before delivery. After the baby is born, the doctor or other health care provider has a small window of time -- about 15 minutes or so -- in which to clamp and cut the cord, then collect the cord blood. After that, the cord essentially clamps itself off from the exposure to air.

There are two collection methods. In the bag method, the doctor attaches a bag (just like the one attached to an IV) to the cut end of the cord and elevates the cord, allowing the blood to drain into the bag. In the syringe method, the doctor inserts a syringe into the cord and draws blood out, much like blood is drawn from a vein.

Proponents of cord-blood collection say that it's completely harmless to both the mother and child; after all, in most cases, the cord is clamped, cut and thrown away. However, some critics argue that in the rush to collect the cord blood, the procedure is sometimes performed too early. Usually some of the blood flows back into the baby before the cord is clamped, and they argue that early clamping deprives the baby of much-needed oxygenated blood and can even raise the likelihood of certain childhood diseases.

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A maternity assistant (L) demonstrates how to cut the umbilical cord to a pregnant woman during a childbirth training class.

China Photos/Getty Images

After it's collected, the cord blood must be frozen in liquid nitrogen to preserve it. Theoretically, it can last forever. Here parents must make another decision -- public cord blood bank or private cord blood bank? There's a network of public cord blood banks across the United States and in many other countries. Parents can check to see which bank their hospital uses. The bank provides the collection kit and pays for the blood to be processed, tested and stored; it's completely free to the parents. Sending your baby's cord blood to a public bank is like donating blood; it's not stored for you, but for anybody who needs it.

If parents choose to store the blood in a private cord blood bank, they must pay for the collection, testing and storage. The initial fee can be up to $2,000, and there's an annual storage fee as well, usually around $100. Here's where cord blood banking itself becomes controversial, because unlike public banks, private banks turn a profit. Some private cord blood banks have been accused of misleading parents about the potential uses of their baby's cord blood.

Currently, public cord blood banking has the most acceptance by the general medical community. Private banking is illegal in some countries, because many medical professionals consider the likelihood of the family actually using the blood to be very low. We'll look at that likelihood, as well as how CBE stem cells can be used, next.

Placentophagy

After most hospital births, the placenta is discarded. Even before the cord blood movement, however, there were some people who chose to save the placenta. Some traditions proscribe that the placenta is to be buried at the base of a tree, which grows as the child grows. Other women (and sometimes their families and friends) actually eat their placenta. It's known as placentophagy.

Proponents argue that the placenta is full of nutrients. They also claim it contains compounds that reduce pain, encourage the production of milk and prevent complications such as post-partum depression. Many other placental mammals, including dogs and cats, regularly eat the placentas and umbilical cords of their young. However, many gynecologists point out that people generally don't need the nutrition, and that the benefits are actually very minimal.

In the first section, we talked about how similar CBE stem cells are to embryonic stem cells. However, they aren't the same thing as embryonic stem cells. CBE stem cells have even more potential for use than stem cells taken from adult bone marrow because a perfect match between the donor and the recipient isn't necessary.

So how likely it is that your child would need to use his or her cord blood? What about using any cord blood? The numbers vary widely. According to a recent article in the medical journal "Biology of Blood and Marrow Transplantation," the likelihood that a person would need an autologous CBE transplant (his or her own cells) during his or her lifetime is about 1 in 435, and the likelihood that he or she would need an allogeneic CBE transplant (cells from a donor, either a relative or stranger) is 1 in 400. But other studies have put both the odds of needing an autologous or an allogeneic transplant at anywhere from 1 in 2,000 to 1 in 200,000, depending on whether the family has a history of a disease that's treatable with CBE stem calls. In short, researchers can't yet be sure, because CBE stem cell transplantation is still experimental.

Since 1988, there have been several successful allogeneic CBE transplants between siblings. However, even stem cells between siblings only have a 25 percent chance of being a match. In addition, according to the National Marrow Donor Program, only about half of the donations to public banks are suitable for storage. In some cases, the cord blood isn't stored because it doesn't contain enough stem cells. Adults can't usually receive cord blood transplants because there aren't enough stem cells for a person who weighs more than 100 pounds.

Some parents mistakenly believe that their child could be treated with his or her own cord blood if he or she contracts leukemia later on. But leukemic cells are present at birth, so the cord blood would be tainted. The same goes for many other disorders. Currently, researchers don't have uses for autologous CBE stem cell transplants. There have been several allogeneic uses of CBE stem cells for leukemia and other cancers, as well as immune disorders. They have also been used to treat conditions such as Type 1 diabetes.

Groups like the American Academy of Pediatrics advise parents to donate their baby's cord blood to public banks, citing the current statistics. Some physicians suggest privately banking a baby's cord blood only if the family has a history of a CBE-stem-cell-treatable disease. But many private banks and cord-blood banking advocates say that private banking is worth it, because we can't yet know how CBE stem cells will be used in the future.

Should you save your baby's cord blood? Right now, the answer looks to be yes ... but in public banks so that everyone can benefit from its potential use.

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